Anyone with insurance knowledge able to help me understand what this means? I found this in my benefits plan and I am unsure how to interpret it. I have a $2500 deductible, so I know I am going to pay almost full price for my equipment (if there is in fact a contracted rate available). But does this mean that I have to pay the rental fee until the stuff is paid off and then I keep it or give it back? I was just given an Rx for the AirSense 10 AutoSet for Her with the heated hose and a P10 mask. Not sure if my insurance will cover it based on the section I bolded below. Anyone have experience with BCBS PPO with high deductible
DURABLE MEDICAL EQUIPMENT (DME), MEDICAL SUPPLIES AND PROSTHETIC
APPLIANCES AND ORTHOTICS
Precertification: Not required.
Your Cost-Share: You pay applicable deductible and coinsurance. Your cost-share is waived for one
FDA-approved manual or electric breast pump and breast pump supplies per female member, per
calendar year. You also pay the balance bill for services provided by noncontracted providers.
H.1 Durable Medical Equipment (DME)
Benefit Description: To be eligible for coverage, DME must meet all of the following criteria:
• Be designed for repeated medical use in the home setting;
• Be specifically designed to improve or support the function of a body part;
• Cannot be primarily useful to a person in the absence of an illness or injury; and
• Intended to prevent further deterioration of the medical condition for which the equipment has
been prescribed.
Benefits are available for DME rental up to the purchase price of the item, as determined by
BCBSAZ, and for DME repair or replacement due to normal wear and tear caused by use of the item
in accordance with the manufacturer’s instructions or due to growth of a child. Benefits are limited to
the allowed amount for the DME item base model. BCBSAZ determines what is covered as the base
model. Deluxe or upgraded DME items may be eligible for coverage based upon BCBSAZ medical
necessity criteria.
Benefit-Specific Exclusions:
• Charges for continued rental of a DME item after the purchase price is reached (what does this mean...wont I own it after reaching the purchase price if rented? In a rent to own sense?)
• Repair costs that exceed the replacement cost of the DME item
• Repair or replacement of DME items lost or damaged due to neglect or use that is not in
accordance with the manufacturer’s instructions or specifications
Thanks in advance for any insight